Self-inspection and temperature log

Please make note of the following information and procedures regarding the self-inspection form with temperature log. Below is a guide to the information you will need when filling out the self-inspection and temperature log (PDF) forms.

Self-inspection form

This form allows for information to be recorded during daily checks. Each form has enough space to record a full week, with a box available for each day of the week, from Sunday through Saturday. In each box, check each item after completion, record proper information, and document corrective actions.

  • Certified food manager/person in charge: There must be a person in charge at all times.
  • Handwashing facilities: Unobstructed, clean, equipped with soap, paper towels, and fingernail brush.
  • Illness reporting: Are there any ill employees? Document name, date, illness, and associated symptoms on the illness log.
  • Employee health and hygiene: Washing hands after eating, drinking, using toilet, smoking, after raw meat prep. Using gloves with ready-to-eat foods. Hair restraint, clean clothing.
  • Food: Proper records, shellfish tags, etc. No spoilage, in original containers, labeled, dated, 6 inches off floor, covered and organized.
  • Cross-contamination: Raw meats, raw eggs, unwashed vegetables below and separate. Ice/food dispensing scoops out of product. Safe preparation methods.
  • Sanitizers: Bleach—50–200ppm; Quaternary Ammonia—200–400ppm; Iodine—12.5–25mg/L. Record measurements for each in the morning and the afternoon/evening.
  • Three compartment sink: Record sanitizer concentration in parts per million.
  • Dishwashing Rinse Temp: at least 180°F. Record temperature.
  • Food contact surfaces: All sinks, prep tables, and equipment are thoroughly cleaned and sanitized. Equipment has been taken apart, cleaned and sanitized.
  • Non-food contact surfaces: All utensils and equipment are clean and stored in the correct area. All floors, walls, and ceilings are clean.
  • Rodent and pest prevention: Any evidence of rodents or pests? Dumpster lids are closed, no gaps or holes, licensed pet control.
  • Chemical storage: All chemicals and toxics are labeled and away from/below food preparation and storage areas. Lotions and Kleenex are stored separately.
  • Water: Hot/cold water pressure. Hot water temperature: 110–130°F. No cross-connections or back-siphonage. Back-flow device in place along with approved waste system.
  • HACCP Program (if applicable): Is it in place, used, and reviewed daily by person-in-charge? All HACCP plans must be approved.

Daily temperature log

This form allows for information to be recorded during daily checks. Each form has enough space to record a full week, with sections available for each day of the week, from Monday through Sunday. In each section, in both the a.m. and the p.m., please record the unit name and temperature along with the names of foods and their corresponding temperatures. Each temperature recording needs to be initialed.

Reminders: All food should be heated to the proper temperatures, which are dependent on the type of food served. Be sure to keep all cold foods at 41°F or below. When reheating foods heat to 165°F or above and maintain at 140°F or above. All hot foods must be maintained at 140°F or above. When cooling foods, use proper procedures, 70°F after 2 hours, then 41°F after 4 hours. If you have any further questions regarding proper food temperatures, please contact the Minnetonka Environmental Health Division at 952.939.8272.